Will Saletan writes about politics, science, technology, and other stuff for Slate. He’s the author of Bearing Right.

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A breast implant company disclosed a decline in surgeries late last year; a laser eye-surgery firm has lowered its forecast based on a similar trend early this year. A professional breast augmenter frets that in January and February, business for some of his colleagues was off 30 percent to 40 percent. ... More effectively than any bioethicist, the recession is reminding people that cosmetic work isn't medicine. "While healthcare spending as a whole has traditionally moved independently of the economy—a safe haven—that really isn't the case with plastic surgery," a financial analyst tells the
Times
. In the new, sobered economy, the paper reports, some cosmetic doctors are diversifying into "reconstructive surgery for cancer patients and others that is covered by insurance." Insurance!

Say what you will about coverage-denying bean counters, but they do enforce the essential priority of urgent procedures over elective ones. In a health-care industry controlled by tight budgets and insurers, you might even see the cream of the med-school crop shift back to the kind of work that keeps people alive.

Johnson & Johnson said [Dec. 1] it would buy Mentor, a maker of cosmetic products and breast implants, for $1.07 billion, a move that would help the drug maker become a major player in cosmetic and reconstructive surgery. Analysts said Johnson & Johnson was paying "a giant premium" for Mentor, which makes MemoryGel breast implants, liposuction equipment and skin repair products. ... "It's a good space for J.& J. to get bigger in because it's a space with the least cost-control pricing pressures," as patients, rather than insurers or government health programs, generally pay for cosmetic surgery, said Erik Gordon, associate dean and head of biomedical industry programs at Stevens Institute of Technology.

In other words, the increasing power of insurance gatekeepers and cost controls, driven by the recession, might drive some companies out of health-oriented medicine and into cosmetic procedures. The inability of middle-class people to pay for boob jobs doesn't mean providers have to shift their focus to real medicine for the middle class. Maybe they'll shift their focus instead to boob jobs for the rich.

True, the rich are a smaller market than the middle class. But if the cost controls in real medicine are too tight, providers can make up in profit margins what they lose in volume. So, as we're revising our health-care system, let's try not to drive too many doctors and health companies out of real medicine. They might have something less important to do.

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